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SPINAL TUMORS

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A spinal tumor is nothing but a growth of cells or a mass in or surrounding the spinal cord. If put in other words, spinal tumors are neoplasms located in the spinal cord. Extradural tumors are more common than intradural neoplasms.

Any type of tumor may occur in the spine including Leukemia, Lymphoma or Myeloma.

There are a small number of spinal tumors that can occur in the nerves of the spinal cord itself. Most often than not, these are ependymomas and other gliomas. Tumors may spread to the spine from the breast, prostate, lung, and other areas. Tumors that start in spinal tissue are called primary spinal tumors. Tumors that spread to the spine from some other place like metastasis are called secondary spinal tumors.

Spinal cord compression is commonly found in patients with metastatic malignancy. Back pain is a primary symptom of spinal cord compression in patients with known malignancy. It may prompt a bone scan to confirm or exclude spinal metastasis. Rapid identification and intervention of malignant spinal tumors, often causing spinal cord compression, is key to maintaining quality of life in patients.

However, the cause of primary spinal tumors is unknown. Some primary spinal tumors occur with genetic defects. Spinal tumors can occur inside the spinal cord which is called intramedullary. It can also occur in the membranes or the meninges covering the spinal cord (extramedullary - intradural) or between the meninges and bones of the spine (extradural). The tumors may extend from other locations. Most spinal tumors are extradural.

As the tumor further grows, it can affect the blood vessels, bones of the spine, meninges, nerve roots or spinal cord cells. The tumor may press on the spinal cord or nerve roots, causing damage. With time, the damage may become permanent.

The symptoms depend on the location, type of tumor, and your general health. Tumors that have spread to the spine from another site (metastatic tumors) often progress quickly. Primary tumors often progress slowly over weeks to years.

Tumors in the spinal cord usually cause symptoms, sometimes over large portions of the body. Tumors outside the spinal cord may grow for a long time before causing nerve damage.

The symptoms seen are due to spinal nerve compression and weakening of the vertebral structure. Incontinence and decreased sensitivity in the saddle area (buttocks) are generally considered warning signs of spinal cord compression by the tumor. Other symptoms of spinal cord compression include lower extremity weakness, sensory loss, and rapid onset paralysis. The diagnosis of primary spinal cord tumors is very difficult, mainly due to its symptoms, which tend to be wrongly attributed to more common and benign degenerative spinal diseases.

Symptoms of it may also include abnormal sensations or loss of sensation. This happens especially in the legs or may be in the knee or ankle, with or without shooting pain down the leg. The patient feels cold sensation of the legs, cool fingers or hands, or coolness of other areas. Another symptom is back pain and it gets worse over time. It occurs in any area -- middle or low back are most common, is usually severe and not relieved by pain medication. It is worse when lying down and is worse with strain, cough, sneeze. The problem may extend to the hip, leg, or feet (or arms), or all extremities.

Depending on their location, the spinal cord tumors can be outside the dura mater lining (most common) or intradural - part of the dura, intramedullary which is inside the spinal cord or extramedullary which is inside the dura, but outside the spinal cord.

Fecal incontinence include inability to keep from leaking urine (urinary incontinence), muscle contractions, twitches, or spasms (fasciculations) or muscle function loss. There is also muscle weakness (decreased muscle strength not due to exercise). It causes falls, especially in the legs and makes walking difficult. It is progressive and may get worse.

A neurological examination may help pinpoint the location of the tumor. The health care provider may also find the following during an exam: Abnormal reflexes, Increased muscle tone, loss of pain and temperature sensation, muscle weakness, tenderness in the spine.

There are tests that may confirm spinal tumor. These tests can be done in major hospitals in India. Places like New Delhi and Nagpur hosts many such hospitals. Hospital in Nagpur is one such hospital. The tests that can be done are: Cerebrospinal fluid (CSF) examination, Cytology (cell studies) of CSF, Myelogram, Spinal CT, Spine MRI and Spine x-ray.

The goal of treatment is to reduce or prevent nerve damage from pressure on (compression of) the spinal cord. Treatment should be given quickly. The more quickly symptoms develop, the sooner treatment is needed to prevent permanent injury. Any new or unexplained back pain in a patient with cancer should be thoroughly investigated.

There are various treatments available. Corticosteroids (dexamethasone) may be given to reduce inflammation and swelling around the spinal cord. Surgery may be needed to relieve compression on the spinal cord. The cost of surgery is quite low in hospitals like Spine and Neuro Surgery Hospital in Nagpur.

The diagnosis of primary spinal cord tumors is difficult, mainly due to their symptoms, which in early stages mimic more common and benign degenerative spinal diseases. MRI and bone scanning are used for diagnostic purposes. This assesses not only the location of the tumor(s) but also their relationship with the spinal cord and the risk of cord compression.

Some tumors can be completely removed. In other cases, part of the tumor may be removed to relieve pressure on the spinal cord. Radiation therapy may be used with, or instead of, surgery.

Chemotherapy has not been proven effective against most spinal tumors, but it may be recommended in some cases. Physical therapy may be needed to improve muscle strength and the ability to function independently.

Surgery is sometimes possible. The goals of surgical treatment for spinal tumors can include histologic diagnosis, tumor local control or oncological cure, pain relief, spinal cord decompression and restoration of neurological function, restoration of spine stability, and deformity rectification.

The combination of Minimally Invasive Surgery and Radiation or Chemotherapy is a new, minimally invasive technique, pioneered at Mount Sinai Hospital, New York by Dr. Arthur Jenkins. This treatment can be tailored to the particular tumor of the spine, either metastatic or primary.

Some suggest that direct decompressive surgery combined with postoperative radiotherapy provide better outcomes than treatment with radiotherapy alone for patients with spinal cord compression due to metastatic cancer. It is also important to take into consideration the prognosis of the patients and their ambulation status at diagnosis, and treat accordingly.

The outcome varies depending on the tumor. Early diagnosis and treatment usually leads to a better outcome. Nerve damage often continues, even after surgery. Although some amount of permanent disability is likely, treatment may delay major disability and death. There are possible complications like incontinence, life-threatening spinal cord compression, loss of sensation, paralysis, and permanent damage to nerves and disability from nerve damage.

Steroids (e.g. corticosteroids) may be administered if there is evidence of spinal cord compression. These do not affect the tumoral mass itself, but tend to reduce the inflammatory reaction around it, and thus decrease the overall volume of the mass impinging on the spinal cord.

Radiotherapy may be administered to patients with malignant tumors. Radiation is usually delivered to the involved segment in the spinal cord as well as to the uninvolved segment above and below the involved segment. Cancer can affect the spine and its components by a number of types of spinal tumors. Most tumors in the spine are metastatic-they spread from another part of the body into the spinal region and cause pain.

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